Q: Hi Dr, please I need advice. I am a Nigerian. I just traveled to US to have my baby and am 38 weeks gone but the problem is dis. I’ve had 3 children previously and all of them were induced before they came: one at 42 weeks, 41 weeks and 39 weeks respectively. Since 34 weeks I’ve being having contraction just like the previous pregnancies. And I have told them this is just how others were and that the baby won’t just come until I am induced. Yet they refused, saying that it must be up to 41 weeks before they do that or unless there are any complications. But my problem is that all my children were all big ranging from 4.1 kg to 4.6 kg and the more I wait the more the baby is adding weight. Please Dr advice me accordingly as I don’t know what to do now.

A: Usually pregnancy lasts for 40 completed weeks plus or minus 2 weeks. Generally though, from 37 weeks, your baby is good to be born…all things being equal. And so, if a woman gets to 40 weeks without any sign of labour, she is tentatively given 2 more weeks, especially if there are no other risk factors present in the pregnancy. This is called watchful waiting and during this period, the baby’s kicks are counted, baby’s heart beat is monitored and indeed, baby’s growth and other parameters are monitored. From the 41st week, if she does not spontaneously go into labour (without help), then there is a plan made for induction, having fully informed the woman of all possible scenarios. Some women do not like the idea of induction and so, having discussed with the medical team, may opt for a sweep of the membranes. This involves the separation of the membranes (the ‘bag’ in which the baby lies) from the lower part of the womb (uterus). This releases prostaglandins which help stimulate labour. In your case, it appears to be different as you do not mind induction 😀

When a pregnancy goes beyond the Expected Date of Delivery (EDD) which is 40 weeks, it is called a post-dated pregnancy. If the pregnancy lasts beyond 42 weeks, it is called post term. It is not really clear why some pregnancies become post-dated but some associated risk factors include previous post-dated pregnancy, first pregnancies, mothers with high BMI and advanced age.

The main challenge with allowing a baby to remain in the womb beyond the 42nd week is that of the placenta no longer being able to supply sufficient amounts of oxygen to the baby. This can lead to brain damage or even death of the baby. The second issue is the threat of the baby having its first poop inside the womb and then aspirating (breathing in) same. As you have noted, the baby may also become bigger (fetal macrosomia) with potentials for complications like genital tract tears during vaginal delivery, prolonged labour etc. However, some studies have indicated that induction of labour in fetal macrosomia does not change the risks to mother or baby and if you’re in a good center, these complications are anticipated and indeed, prepared for to ensure they don’t happen.

Generally, it appears that your medical team is making plans to induce by the 41st week, which is standard. Your fears about the baby getting bigger is valid but as noted above, induction may not alter the associated risks. So, I would suggest that you have a long chat with your medical team and discuss all options available and the ones you are comfortable with. If they do not appear concerned, they need to share the reasons for that with you so that you can also trust their judgement.

Remember that you can also ask for a second opinion if you are not comfortable.

All the best! Let’s know when the baby is born! Lots of love and hugs.